kevkei

I doubt that they are 'calibrated' to differentiate between venous VS. capillary blood. Blood is blood, all it is looking for is a glucose level. Just as pulse oximetry lacks sensitivity and specificity for what is bound to hemoglobin. Now, stating there is a 10-20% variance between the two, which in his opinion is lower of them?

Lithium, my point is that there are factors to affinity more than natural affinity and physiological conditions. Affinity is also affected by drug concentration when you have competing agonist/antagonist. Take your exampleof 2 horny males, male 'A' (narcan) and male 'B' (morphine). All things being equal, male 'A' and 'B' racing to the door. If male 'A' (narcan) is bigger and faster, but also better looking, he might win compared to male 'B' who is smaller and slower. But what if male 'B' brings along a bunch of friends that help remove male 'A' from the girl just as they got started? Male 'A' isn't beaten up or removed from the house, and once in a while he might sneak in and remove male 'B' and bind with the receptor (to bad he can't stimulate it because he has no efficacy :shock: ) but then 'B's friends come along and 'competatively' remove 'A'. Eventually, male 'A' loses interest and leaves the scene unless he calls for back-up himself. In summary, male 'A' has a higher affinity than male 'B'. Male 'B' happens to have more friends which eventually help him have higher affinity to the girl. Here's a hint, when you have a chronic user that has had many EMS transports to hospital "Usually he starts to breathe after 0.4 mg IV but today it took 4 mg to get an increased respiratory rate." If a patient has S&S indicative of a narcotic toxidrome triad (miosis, altered LOC and bradypnea/apnea), I would think that receptor occupancy is darn near 100% regardless of how much they took. If a chronic user will normally get to this point with 20 mg of MS, what happens if they take 40 mg? Nothing! It will however change how much narcan it will take to effect your desired response.

Take a patient that has been given two seperate doses of a narcotic but all other things being equal, say 10 mg and 20 mg respectively of morphine. If you administer 2 mg of narcan IVP to both situations, your saying that the effects of the narcan will last 45 minutes in both situations? I say I disagree. The affinity that a drug has for a receptor is influenced primarily by two factors: 1) the natural affinity the free drug has for the receptor, 2) the concentration of the drug. Other factors include things like pH, bioavailability. In this situation, although narcan typically has a higher natural affinity to mu and kappa receptors than most opioids, it is competing with a higher drug concentration. The higher plasma drug concentration the higher it's said affinity for the receptor site and it's ability to actually remove the narcan from the receptor. This will result in less bound narcan and more free drug, which leads to metabolization and elimination.

I disagree. Narcan doesn't have a specific half life if it is bound. As long as it is competatively binding to a receptor site, it's affinity depends on the affinity and concentration of the drug it is competing with. For example, if a patient has 10 mg of morphine in his system versus 20 mg, the narcan will wear off faster in the 20 mg scenario due to the plasma concentrations of the morphine.

NO, NO, NO, NO, NO. Did I say NO? As a healthcare professional that is supposed to do no harm, unless you can also give a benzodiazepine, no. Does an Intermediate do this???? On the genius topic of Romazicon, NO, NO, NO, NO, NO, NO, NO, NO, NO, NO. Unless you can give a different anticonvulsant like Dilantin, no. Can an Intermediate do this either??? Ever seen a flash pulmonary edema after narcan administration? How would you treat that? Unless you can accept the fact that there is no 'safe' or 'benign' medication and understand why, then no.

Have you tried looking on PubMed? Look here, without sorting, I found 109 articles entering 'prehsopital entonox' Prehospital Entonox Use

Actually, there is a program in our inner City called Street Works that is training laypersons from the community to recognize and administer IM narcan. Basically, they are a known narcotic user and found unresponsive.

Agreed. These things are bad m'kay.

Sorry, but quality isn't any better than quantity. In Edmonton, I will see at least one CTAS-2 every 4 days and in between see 6-8 others a day (1,3,4,5). You need patient contact to become a better caregiver. You also need a strong background, the right personality, good training (each institution has something to offer to different types of students, so one is really no better than others) and experience. Experience takes years if you only see 1 patient every 3-4 days, regardless of their acuity.

This has got to be the stupidest and most nieve saying there is. :roll: I have yet to see anyone qualify or substantiate this statement. Absolutely correct someone if they are wrong, just be 100% certain that you are right and they are wrong. I have had people of the same level of care and lower try to tell me that I was wrong when in fact they were in the wrong and found out such by doing a little studying and research. At the same time, I've had people say "hey, have you thought of this" or "did you know this..." It's all about tact and diplomacy, and has been stated, how you broach the subject. Team work is suggestive of two or more people working together for a common goal. We have all made mistakes and we learn from them and it makes us better as caregivers.

Yes, it is in the standards for Paramedics. Not only that, but also tailoring and treating to qualitative benchmarks dependent on underlying factors and pathophysiology.

Sure BiPap and PEEP, but not in an arrest. That's where you'll really run into trouble. We've been hearing about doing this around here for a while although it's not in protocols or standard of care. Another little trick in a known or suspected asthmatic arrest is dropping some epi down the tube once they are intubated, even with IV access. It works great for direct Beta II stimulation.

I hear that Hawaii is beautiful at this time of year. I think that my favorite location on the islands to enjoy a Mount & Do would have to be ComeonIwannalayyou. :^o

If there was anything I learned at a CBRN (Chemical, Biological, Radiological and Nuclear) course, it was: "The solution to polution is dilution." Contralaterally, the more 'card carrying people' and the more 'volunteers' (polution)you have, the more diluted the workforce is (supply and demand) and the less you can demand as a profession (solution) and as employee's. Yes there may be a need for volunteers on a few and very isolated cases, but to justify volunteer services beacuse the cost can't be supported is false.

I wholeheartedly agree with Bledsoe. These are the same reasons why many of us up north of you brag about our programs and why sometimes we come off as arrogant and eletist. More than that, it's because we are proud of our training. Personally, I used 18 textbooks for my program, I'm sitting at 4000 hours worth of training to become a Paramedic. Does this mean I know it all? Well, yes, but that's besides the point (kidding). The moment we think we know it all, or stop making the effort to learn is the day we die as a good caregiver. On the subject of 'grandfathering' and 'I've been doing this for 10 years' our regulatory College requires all caregivers to upgrade their training because of a National Competency Profile as well as increasing our scope of practice ( seeAlberta GAP Training ). If you don't want to or refuse to do this, you lose your right to practice. Here is what is comprised in the upgrades, at each respective level. EMR - Airway Module, Pharmacology Module, Trauma and MCI Module. EMT - Airway Module, Cardiac Monitoring Module, IV Therapy Module, Pharmacology Module, Trauma and MCI Module, EMT-P - Arterial Blood Gas Samples Module, Blood Products Module, Chest Tubes Module, Femoral Venipuncture Module, Intraosseous Module, Intrapartal Exam Module, Nasotracheal Intubation Module, Suturing and Hemostat Module TCP Module, Urinary Catheterization Module. The good thing with these areas is it will be a significant wakeup call for those that think they know it all or haven't picked up a textbook or journal or attended rounds in eons.

Haven't we already beaten this subject to death ????????????????????????????????

Not only left lateral recumbent but also a slight Trendelenberg position.

Anyone interested in Edmonton's, send me a PM with an e-mail address and I'll see what I can do.

Dude, wasn't your last parter also male? :twisted:

At most, continuous (keep in mind this is over 2-3 hours) albuterol has been shown to decrease serum potassium up to 0.3 - 0.5 mmol/L, or 10% of normal limits. Also remember that treatment of moderate to severe hyperkalemia is multifacited. Also, because the lowering of potassium from albuterol use/administration is self limiting and reverses after the albuterol has been metabolized. Why? Because the potassium never leaves the body, it is only redistributed into the cell. Unless you give lasix, a potassium resin (Kaexolate) or dialysis, the potassium remains in the body and it is only temporary.

So this confirms what we all already suspected. So what? I think it is unrealistic to summise that we discontinue on the basis that during transit, compression quality deteriorates. There are more influential and supportive arguments than this for this practice. There are also certain patients that we can't call on scene and therefore have to transport. Don't get me wrong, my preference is to work a code to it's fullest and if appropriate, discontinue on scene.

I was so sick last night and I didn't get much sleep :pukeleft: :pottytrain5: :pukeright: but I didn't want to burden the service :wink: with a sick call in so I motivated myself to come in for the good of the department. :-({|= (If you sell it well enough, and can mimic symptoms, they may send you some out of sympathy) :wink: (NOT)

Sorry about that. I should have read what I wrote before submitting, but we got called out. It should have read more like this: Actually, D5W although initially is isotonic, once the glucose is taken up at the cellular level (which is quickly) or processed into glycogen, it becomes hypotonic and will eventually worsen circulatory volume by first drawing water into the interstitial compartment due to osmosis (natural movement of solute and solvent) and oncotic (pull) pressure, but that fluid will eventually re-distribute into the vascular system. The only way to get rid of volume overload is third spacing (temporary), diuresis or dialysis. Keep in mind that osmosis and oncotic gradients cause fluid to continually move back and forth until an equilibrium is established. I think that in reality, the dextrose in the solution does not stay in the vascular system for long enough to make a sensible change insofar as drawing interstitial fluid into the vasculature. What it does do is add whatever volume of water you administer to the total body volume that eventually ends up somewhere. As for the CHF patient's you are talking about, where is the edema occuring that you are trying to correct? If it is pulmonary (left heart failure), attempts to redistribute fluid into the interstitium or vasculature won't really help. What you want to do is potentially decrease preload and afterload (hydrostatic pressure) and drive the edema back across the alveolar membrane. You aren't going to pull the pulmonary edema back across by increasing oncotic pressure, but if you decrease hydrostatic pressure, you will decrease the causal problem, then you can fix it. Now I;m confused :wink:

Actually, D5W although initially is isotonic, once the glucose is taken up at the cellular level (which is quickly), it becomes hypotonic and worsens circulatory volume by drawing water into the vascular compartment due to osmosis and oncotic pressure. As for the bad evaluation, look at the source. The guy would probably give a bad eval for not giving SL nitro to a RVI too.

Ahh, therein lies the connundrom. Typically pt's with CHF in isolation don't suffer chronic dyspnea, this would suggest more of an obstructive component of COPD with the CHF. If a patient gets to the point of requiring intubation, it's not a concern, because they need it in order to live. Weaning from a vent can be a problem, but there are many ways to overcome it. Things like permissive hypercapnea, pressure support (meaning they have to breathe to trigger the vent), etc.